Provider Demographics
NPI:1174803803
Name:COLBY, SHIRLEY (DDS)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:COLBY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 N M ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-4138
Mailing Address - Country:US
Mailing Address - Phone:559-688-7529
Mailing Address - Fax:559-688-1223
Practice Address - Street 1:233 N M ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4138
Practice Address - Country:US
Practice Address - Phone:559-688-7529
Practice Address - Fax:559-688-1223
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA605161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice